MEDICARE: KAREN HUSEBY MOORE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	79719	WI
2	363L00000X	Nurse Practitioner	1433	WI

General Provider Information

NPI Number	:	1467420828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN HUSEBY MOORE NP

Provider Business Mailing Address
First Line	:	413 HUMMINGBIRD LN
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-3343
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 HUMMINGBIRD LN
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53714-3343
Country	:	US
Telephone Number	:	608-219-3433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	08/09/2021

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